When I published my last post about mental health, I had just learned that designer and fashion icon Kate Spade had died from suicide. It was a blow that no one saw coming and it shocked all of us. Three days later, Anthony Bourdain, an amazing chef, storyteller, and one of my personal idols also died from suicide. It was a horrible week.
It also shined a blinding spotlight on mental illness. The general public was thrust into the reality that millions of people all over the world experience with all too much regularity. Over and over on social media, I read pleas from friends that if you were struggling to please reach out for help. People posted the phone number for the National Suicide Prevention Lifeline. Other people urged those of us with mental illness to seek therapy or medication. All of these suggestions came from a place of love but also from a place of powerlessness. There was a sense of helplessness underlying these messages. It dawned on me that though well-intentioned and coming from a place of caring, many people really don’t know what it’s like to be in the depths of depression and anxiety and how the act of reaching out for help ,many times, feels completely impossible.
I was 25 when I first sought out a therapist to help me with anxiety and depression. I had had a devastating experience six years prior. I had fallen in love with a guy named Doug. Doug was amazing! Funny, smart, a bit of rebel (which really spoke to my rules-following-good-girl heart). Doug was also sick. He had cystic fibrosis. In 1997 the prognosis for people living with cystic fibrosis was grim. He was 24 and and always known and accepted that his life wouldn’t be a long one but he lived it in the best way possible. We fell in love with each other quickly but during that short time he became very sick. He was hospitalized back home in Michigan. A good friend of his called me up one evening and told me that if I wanted to see him then I needed to get up to Detroit ASAP.
So at 19 years old, I boarded a plane and flew to a city I’d never been to, to stay with people I didn’t know, and to lose someone I had fallen in love with. Doug died a short four days after I arrived. I had the blessing and honor (I feel that now) to be with him to the very end and to tell him how much I loved him and how much he was loved.
I was devastated. I cried every single moment as I flew back home to Austin. Since this was before 9/11, anyone could meet passengers at the gates. My mother met me at the terminal and wrapped me in her arms. I found myself cycling through moments of numbness and intense, overwhelming emotional pain. That first night at home was horrific. I had never experienced loss in that way before and it was as if my soul had cracked wide open. I cried in keening wails of grief. It was enough to scare my sister. It was enough to upset my father. That night I remember so clearly the words he spoke, “You can’t bring him back. He’s dead. Crying and carrying on won’t help.”
So that was that. That was how we dealt with pain in my family. I don’t hold it against my father. My father learned to handle grief the best way he knew how. I repressed my grief as deep as I could. In return, my mind began to toil in anxiety. When those feeling became too much, I repressed those too.
For six years I stayed in this state. I faked it until I made it. No one, at least I thought, was the wiser. And then I broke.
I was lucky that at the time I broke I was also in a relationship with a guy, PM, who had gone through his own trauma and recovery. He and I had been seeing each other off and on for about four years. He was experiencing his battle while I was trying to keep it together. When I finally couldn’t take the anxiety and depression any more, he was the one who said that I needed to talk to someone. He battled anxiety and addiction for a large part of his life and he told me that the best thing to do was to see a therapist. It had really helped him, he told me.
I didn’t want to. I didn’t think I needed to. I didn’t think my problems were significant enough to need a therapist. I’m just a little sad. It’s not a big deal. A therapist will just tell me I’m normal and to just get over it, I thought. It’s not like anything really bad has ever happened to me. My problems are tiny compared to people with real problems. I figured since I didn’t try to self-medicate with booze or drugs (I did self-medicate with food, though) and that I could sleep at night (and all day and usually the next day, too.) And that my relationship with PM was fairly health (except I wasn’t always that interested in being intimate because I would rather just sleep), then I didn’t need a therapist. I didn’t have real problems.
But PM kept gently pushing and I gave in. It took me three weeks to actually call the therapist that was recommended to me. I would dial the number and then hang up. I would write it in my calendar as a “To-do” item and then scratch it out. After a particularly awful day, I finally mustered the courage to call and as the phone rang on the other end, I prayed that the therapist wouldn’t pick up.
No such luck. She answered her phone and said, “This is Dr. S.” I could barely speak above a whisper and then once I found my voice, every thing just tumbled out. I spoke at lightning speed. I remember saying, “I don’t know why I’m calling. I’m sure I’m just fine. But my boyfriend PM said I should call, but I’m sure I’m fine. I’m fine. Really I’m fine.” Ha! Sure I was fine! I was also crying hysterically and could hardly catch my breath. Dr. S is a fine, compassionate, and very straight forward therapist. That day was one of the hardest days in my life, but it was one of the best. I worked with her for about four years and she helped me move through the grief and taught me how to live with anxiety and depression.
So yes, I had a successful experience (and continue to since I’m back with Dr. S now.) But that doesn’t mean that it wasn’t an extremely difficult process to begin. Getting help for mental illness is extremely difficult. It’s difficult emotionally and mentally, and for some, physically. The act of making a phone call can seem impossible. Secondly, mental health therapy and services are not available to everyone. There may not be providers in a person’s area. The cost is often prohibitive. Many people don’t have medical insurance and those that do may not have any providers covered under their plan. My two mental health providers (Dr. S, a psychologist and my psychiatric mental health nurse practitioner who prescribes my meds) do not take my health insurance, so I have to pay out of pocket to see both of them. I have had a total of eight appointments between the two of them in the last two months and have paid over $1,500. But I’m lucky. I’m in a position where I can manage that for now. How many people aren’t?
One question I get when I talk about how cost affects access to mental health care is “Well, why don’t you find a provider who takes your insurance?” Indeed. Why don’t I? It would only cost me $35 per session as that is my co-pay. However, the rapport and relationship I’ve built with my therapists is irreplaceable. How many people do you know won’t even change hair stylists? Yeah. So asking someone to leave an established relationship with their mental health therapist is a very tall order.
Therapy is an excellent option for getting help with mental illness. It’s not the only option, though, and sometimes it takes a toolbox of options to help someone achieve recovery. For many years therapy did the trick, but then came a point when I needed more. I sought out a provider who could prescribe appropriate medication and counsel (my nurse practitioner is also a licensed professional counselor). When I began to see her, the medication and counseling combo was what I needed. In addition to two prescription medications (Effexor and Klonopin), she also recommended vitamin D3, B12, a probiotic, and a medical food called l-methylfolate (Deplin). In combination with therapy, regular exercise, some breathing and centering exercises, and better sleep hygeine, my anxiety and depression became manageable.
I’m now back on that regimen in addition to seeing Dr. S. Things are improving. But sometimes a patient will have to try dozens of medications before finding the right one. Sometimes she’ll have to go through a number of therapists to find the right fit. Sometimes the healing process becomes so overwhelming that it can antagonize those awful feelings of despair and worry that it feels like you’ll never feel better. Sometimes those feelings become so heavy and so oppressive that you don’t remember what it was like not feel that way. The tunnel becomes long and cold and lonely and you can’t see a way out.
This is how mental illness works. It can be a life-long battle as was the case for Kate Spade and Anthony Bourdain. That battle can be so hard and so painful that for the mind in the throes of unimaginable pain, the only way out is suicide. I only say this so those who have never been in that place understand why suicide would ever feel like an option.
So here is what I recommend to my well meaning, very loving, concerned friends who have friends that struggle with mental illness:
- Reach out first! Call (or text or message) your friend on a regular basis. Just check in. If you haven’t heard from her in awhile, don’t wait for her to call you. She might not. If he doesn’t call back or text back or message back, don’t give up. Keep reaching out.
- Invite your friend to go out, and keep inviting her even if she says no. If he doesn’t want to go out, then tell him them you’re coming over. Of course, we still want to be cognizant of boundaries, but you know you’re friend. Meet her where she is and hold space for her.
- Educate yourself on depression, anxiety, bipolar disorder, and other mental health disorders. Try to understand what it means to be struggling with a mental illness. Work on changing your assumptions and when you have the chance, speak up to dispel the myths that seem to be everywhere about having mental illness.
- Have patience and keep connecting. We’re doing the best we can in the moment and while it may seem that we’re not reciprocating the effort, understand that it isn’t because we don’t love you or don’t care. We just can’t right now.